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Fusco JC, Abdelhafeez AH, Krauel L, Honeyman JN, Ehrlich PF, Wijnen M, Lautz TB, Pachl M, Malek MM. Imaging adjuvants in pediatric surgical oncology. Pediatr Blood Cancer 2025; 72 Suppl 2:e31241. [PMID: 39101518 DOI: 10.1002/pbc.31241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 07/18/2024] [Accepted: 07/19/2024] [Indexed: 08/06/2024]
Abstract
Surgery is a crucial component of pediatric cancer treatment, but conventional methods may lack precision. Image-guided surgery, including fluorescent and radioguided techniques, offers promise for enhancing tumor localization and facilitating precise resection. Intraoperative molecular imaging utilizes agents like indocyanine green to direct surgeons to occult deposits of tumor and to delineate tumor margins. Next-generation agents target tumors directly to improve specificity. Radioguided surgery, employing tracers like metaiodobenzylguanidine (MIBG), complements fluorescent techniques by allowing for detection of tumors at a greater depth. Dual-labeled agents combining both modalities are under development. Three-dimensional modeling and virtual/augmented reality aid in preoperative planning and intraoperative guidance. The above techniques show great promise to benefit patients with pediatric tumors, and their continued development will almost certainly improve surgical outcomes.
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Affiliation(s)
- Joseph C Fusco
- Department of Pediatric Surgery, Monroe Carell Jr. Children's Hospital, Vanderbilt University, Nashville, Tennessee, USA
| | | | - Lucas Krauel
- Department of Surgery, St. Joan de Deu Barcelona Children's Hospital, Barcelona, Spain
| | - Joshua N Honeyman
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Peter F Ehrlich
- Division of Pediatric Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan, USA
| | - Marc Wijnen
- Department of Pediatric Surgery, Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Timothy B Lautz
- Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois, USA
| | - Max Pachl
- Department of Surgery, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Marcus M Malek
- Division of Pediatric General and Thoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Krauel L, Pasten A, Gorostegui M, Mañé S, Martin Giménez MP, Coronas M, Carrasco Torrents R, Mora J. Use of Radioguided Surgery for Small and Difficult-to-Locate Relapsed MIBG (+) High-Risk Neuroblastoma Lesions. Cancers (Basel) 2024; 16:3348. [PMID: 39409967 PMCID: PMC11475745 DOI: 10.3390/cancers16193348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 09/16/2024] [Accepted: 09/26/2024] [Indexed: 10/20/2024] Open
Abstract
INTRODUCTION High-risk neuroblastoma, particularly in the relapse/refractory (R/R) setting, poses unique challenges to obtaining the representative-quality tissue that is mostly required for molecular analysis. This study explores the use of 123I-MIBG radioguided surgery to access complex locations of MIBG-positive neuroblastoma as a tool to overcome the difficulties associated with repeated surgeries in these patients. METHODS This study is a retrospective review of all patients with R/R neuroblastoma and MIBG-uptaking lesions who underwent radioguided surgery between February 2020 and 2023 at SJD Barcelona Children's Hospital. The Europrobe 3.2 gamma probe was used to identify neuroblastoma tissue in the operating room. RESULTS Ten patients were identified. Radioguided surgery was useful in all patients. One patient with previous multiple operations developed an entero-cutaneous fistula with posterior full recovery. Mean surgical time was 111.7 min. The gamma probe identified 100% of neuroblastoma lesions which were all completely removed (123I-MIBG-SPECT/CT negative post-surgery). Pathology and molecular studies could be successfully performed in all samples. CONCLUSIONS 123I-MIBG radioguided surgery proved effective in obtaining viable tissue from difficult-to-access sites in high-risk relapsed neuroblastoma.
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Affiliation(s)
- Lucas Krauel
- Pediatric Surgical Oncology Unit, Department of Pediatric Surgery, SJD Barcelona Children’s Hospital, Universitat de Barcelona, 08950 Barcelona, Spain; (A.P.); (M.P.M.G.); (M.C.); (R.C.T.)
- Pediatric Cancer Center Barcelona (PCCB), SJD Barcelona Children’s Hospital, Universitat de Barcelona, 08950 Barcelona, Spain; (M.G.); (J.M.)
| | - Albert Pasten
- Pediatric Surgical Oncology Unit, Department of Pediatric Surgery, SJD Barcelona Children’s Hospital, Universitat de Barcelona, 08950 Barcelona, Spain; (A.P.); (M.P.M.G.); (M.C.); (R.C.T.)
- Pediatric Cancer Center Barcelona (PCCB), SJD Barcelona Children’s Hospital, Universitat de Barcelona, 08950 Barcelona, Spain; (M.G.); (J.M.)
| | - Maite Gorostegui
- Pediatric Cancer Center Barcelona (PCCB), SJD Barcelona Children’s Hospital, Universitat de Barcelona, 08950 Barcelona, Spain; (M.G.); (J.M.)
| | - Salvador Mañé
- Nuclear Medicine Department, Pediatric Cancer Center Barcelona (PCCB), SJD Barcelona Children’s Hospital, Universitat de Barcelona, 08950 Barcelona, Spain
| | - Marta Pilar Martin Giménez
- Pediatric Surgical Oncology Unit, Department of Pediatric Surgery, SJD Barcelona Children’s Hospital, Universitat de Barcelona, 08950 Barcelona, Spain; (A.P.); (M.P.M.G.); (M.C.); (R.C.T.)
- Pediatric Cancer Center Barcelona (PCCB), SJD Barcelona Children’s Hospital, Universitat de Barcelona, 08950 Barcelona, Spain; (M.G.); (J.M.)
| | - Maria Coronas
- Pediatric Surgical Oncology Unit, Department of Pediatric Surgery, SJD Barcelona Children’s Hospital, Universitat de Barcelona, 08950 Barcelona, Spain; (A.P.); (M.P.M.G.); (M.C.); (R.C.T.)
- Pediatric Cancer Center Barcelona (PCCB), SJD Barcelona Children’s Hospital, Universitat de Barcelona, 08950 Barcelona, Spain; (M.G.); (J.M.)
| | - Rosalia Carrasco Torrents
- Pediatric Surgical Oncology Unit, Department of Pediatric Surgery, SJD Barcelona Children’s Hospital, Universitat de Barcelona, 08950 Barcelona, Spain; (A.P.); (M.P.M.G.); (M.C.); (R.C.T.)
- Pediatric Cancer Center Barcelona (PCCB), SJD Barcelona Children’s Hospital, Universitat de Barcelona, 08950 Barcelona, Spain; (M.G.); (J.M.)
| | - Jaume Mora
- Pediatric Cancer Center Barcelona (PCCB), SJD Barcelona Children’s Hospital, Universitat de Barcelona, 08950 Barcelona, Spain; (M.G.); (J.M.)
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Guidoccio F, Valdés Olmos RA, Vidal-Sicart S, Orsini F, Giammarile F, Mariani G. Radioguided surgery for intraoperative detection of occult lesions. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00064-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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